Jhilam Biswas | Harvard Medical School (original) (raw)

Papers by Jhilam Biswas

CNS Spectrum, 2025

The perspective article explores systemic issues in psychiatric care, particularly the barriers t... more The perspective article explores systemic issues in psychiatric care, particularly the barriers to timely treatment and the ethical dilemmas involved in involuntary interventions. It further examines the impact of anosognosia-lack of disease insight-on treatment, noting the difficulties in managing care for those unaware of their illness, and scrutinizes training materials from international organizations that might mislabel necessary psychiatric practices as human rights violations, thereby complicating the care landscape. The discussion extends to the legal and societal implications of psychiatric interventions, using Massachusetts' Rogers Guardianship as a case study to highlight the consequences of legalistic approaches to mental health treatment. The article calls for destigmatizing psychiatric treatment and integrating robust, evidence-based practices to improve patient outcomes and healthcare equity. The global mental health policy landscape is urged to recognize the critical role of psychiatric care in restoring health and dignity to individuals with serious mental illnesses, advocating for a more nuanced understanding and application of human rights in mental health.

Asian Journal of Psychiatry, 2013

CASE HISTORY History of Present Illness Rosalie is a 21-year-old Dominican woman with current dia... more CASE HISTORY History of Present Illness Rosalie is a 21-year-old Dominican woman with current diagnoses of dissociative identity disorder (DID) and posttraumatic stress disorder (PTSD), and past incorrect diagnoses of schizoaffective disorder, bipolar I disorder, and borderline personality disorder. For over a year she has been at a public sector, long-term, partial hospital program with a residential component focused on dialectical behavior therapy (DBT) skills. Rosalie had been admitted to the DBT program due to her refractory pattern of suicidality, variably described hallucinations and dissociative episodes, and eightyear struggle with a near deadly eating disorder. Since admission to the partial program, Rosalie has been consistently attending skill groups, is on no medication, and has not been hospitalized in the past one-and-a-half years. She has developed her first long-term relationship, which is also her first with a woman. The outpatient world has brought its challenges,...

Journal of the American Academy of Psychiatry and the Law, 2015

In Bernard v. Colvin , 774 F.3d 482 (8th Cir. 2014), the Eighth Circuit Court of Appeals affirmed... more In Bernard v. Colvin , 774 F.3d 482 (8th Cir. 2014), the Eighth Circuit Court of Appeals affirmed the decision of the U.S. District Court of Minnesota, Minneapolis, supporting the Social Security Commissioner's denial of Social Security Disability Insurance (SSDI) benefits and Supplemental Security

During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric tra... more During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric training has wide-reaching cultural value.

Hastings Center Report, 2020

Asian Journal of Psychiatry, 2016

A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versu... more A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.

APA handbook of clinical psychology: Applications and methods (Vol. 3).

Harvard Review of Psychiatry, 2013

American Academy of Psychiatry and Law, 2018

The past few decades have witnessed the steady development of a mental health jurisprudence dedic... more The past few decades have witnessed the steady development of a mental health jurisprudence dedicated to the preservation of human rights. Self-determination and personal autonomy are critical aspects of this perspective, pervading every facet of institutional psychiatric care. Of considerable concern, however, are those cases in which rote procedural approaches produce unintended consequences for the very persons such maneuvers were designed to protect. Delays-inherent in court-based procedures-may ironically lead to an acute illness becoming chronic, and to a single bout of inpatient services being transformed into a lifetime of revolving-door psychiatric admissions. This discussion is not about lawyers or lawyering; rather, it is about the proposition that a better system can and should be devised for advocates who must make do with the options they are dealt. A particularly problematic example is the "Rogers Guardianship" model currently prevalent in Massachusetts. Laws that effectively place on counsel and courts the challenge of second-guessing medical treatment decisions-with minimal latitude for counsel to exercise measured professional judgment-will inevitably generate, and empirically do generate, a degree of delay that ironically deprives patients of the liberation from illness that is the common goal of all stakeholders. Possible solutions to these difficulties are also suggested.

A B S T R A C T A frequent debate in psychiatry is to what extent major psychiatric diagnoses are... more A B S T R A C T A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.

Asian Journal of Psychiatry

Psychiatric Services, 2015

Harvard Review of Psychiatry, 2013

Keywords: dialectical behavior therapy, dissociation, dissociative identity disorder

CNS Spectrum, 2025

The perspective article explores systemic issues in psychiatric care, particularly the barriers t... more The perspective article explores systemic issues in psychiatric care, particularly the barriers to timely treatment and the ethical dilemmas involved in involuntary interventions. It further examines the impact of anosognosia-lack of disease insight-on treatment, noting the difficulties in managing care for those unaware of their illness, and scrutinizes training materials from international organizations that might mislabel necessary psychiatric practices as human rights violations, thereby complicating the care landscape. The discussion extends to the legal and societal implications of psychiatric interventions, using Massachusetts' Rogers Guardianship as a case study to highlight the consequences of legalistic approaches to mental health treatment. The article calls for destigmatizing psychiatric treatment and integrating robust, evidence-based practices to improve patient outcomes and healthcare equity. The global mental health policy landscape is urged to recognize the critical role of psychiatric care in restoring health and dignity to individuals with serious mental illnesses, advocating for a more nuanced understanding and application of human rights in mental health.

Asian Journal of Psychiatry, 2013

CASE HISTORY History of Present Illness Rosalie is a 21-year-old Dominican woman with current dia... more CASE HISTORY History of Present Illness Rosalie is a 21-year-old Dominican woman with current diagnoses of dissociative identity disorder (DID) and posttraumatic stress disorder (PTSD), and past incorrect diagnoses of schizoaffective disorder, bipolar I disorder, and borderline personality disorder. For over a year she has been at a public sector, long-term, partial hospital program with a residential component focused on dialectical behavior therapy (DBT) skills. Rosalie had been admitted to the DBT program due to her refractory pattern of suicidality, variably described hallucinations and dissociative episodes, and eightyear struggle with a near deadly eating disorder. Since admission to the partial program, Rosalie has been consistently attending skill groups, is on no medication, and has not been hospitalized in the past one-and-a-half years. She has developed her first long-term relationship, which is also her first with a woman. The outpatient world has brought its challenges,...

Journal of the American Academy of Psychiatry and the Law, 2015

In Bernard v. Colvin , 774 F.3d 482 (8th Cir. 2014), the Eighth Circuit Court of Appeals affirmed... more In Bernard v. Colvin , 774 F.3d 482 (8th Cir. 2014), the Eighth Circuit Court of Appeals affirmed the decision of the U.S. District Court of Minnesota, Minneapolis, supporting the Social Security Commissioner's denial of Social Security Disability Insurance (SSDI) benefits and Supplemental Security

During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric tra... more During their time in Ayacucho, these visiting psychiatrists learned that American psychiatric training has wide-reaching cultural value.

Hastings Center Report, 2020

Asian Journal of Psychiatry, 2016

A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versu... more A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.

APA handbook of clinical psychology: Applications and methods (Vol. 3).

Harvard Review of Psychiatry, 2013

American Academy of Psychiatry and Law, 2018

The past few decades have witnessed the steady development of a mental health jurisprudence dedic... more The past few decades have witnessed the steady development of a mental health jurisprudence dedicated to the preservation of human rights. Self-determination and personal autonomy are critical aspects of this perspective, pervading every facet of institutional psychiatric care. Of considerable concern, however, are those cases in which rote procedural approaches produce unintended consequences for the very persons such maneuvers were designed to protect. Delays-inherent in court-based procedures-may ironically lead to an acute illness becoming chronic, and to a single bout of inpatient services being transformed into a lifetime of revolving-door psychiatric admissions. This discussion is not about lawyers or lawyering; rather, it is about the proposition that a better system can and should be devised for advocates who must make do with the options they are dealt. A particularly problematic example is the "Rogers Guardianship" model currently prevalent in Massachusetts. Laws that effectively place on counsel and courts the challenge of second-guessing medical treatment decisions-with minimal latitude for counsel to exercise measured professional judgment-will inevitably generate, and empirically do generate, a degree of delay that ironically deprives patients of the liberation from illness that is the common goal of all stakeholders. Possible solutions to these difficulties are also suggested.

A B S T R A C T A frequent debate in psychiatry is to what extent major psychiatric diagnoses are... more A B S T R A C T A frequent debate in psychiatry is to what extent major psychiatric diagnoses are universal versus unique across cultures. We sought to identify cultural variations between psychiatrists' diagnostic practices of mental illness in Boston Massachusetts and Bangalore, India. We surveyed psychiatrists to identify differences in how frequently symptoms appear in major mental illness in two culturally and geographically different cities. Indian psychiatrists found somatic symptoms like pain, sleep and appetite to be significantly more important in depression and violent and aggressive behavior to be significantly more common in mania than did American psychiatrists. American psychiatrists found pessimism about the future to be more significant in depression and pressured speech and marked distractibility to be more significant in mania than among Indian psychiatrists. Both groups agreed the top four symptoms of psychosis were paranoia, lack of insight, delusions and auditory hallucinations and both groups agreed that visual hallucinations and motor peculiarities to be least significant. Despite a different set of resources, both groups noted similar barriers to mental health care access. However, American psychiatrists found substance abuse to be a significant barrier to care whereas Indian psychiatrists found embarrassing the family was a significant barrier to accessing care. Because psychiatrists see a large volume of individuals across different cultures, their collective perception of most common symptoms in psychiatric illness is a tool in finding cultural patterns.

Asian Journal of Psychiatry

Psychiatric Services, 2015

Harvard Review of Psychiatry, 2013

Keywords: dialectical behavior therapy, dissociation, dissociative identity disorder